1140. A Single Dose of Benzathine Pencillin is Sufficient for the Treatment of HIV-infected Persons with Early Syphilis
Session: Oral Abstract Session: Sexually Transmitted Infections
Friday, October 4, 2013: 2:30 PM
Room: The Moscone Center: 250-262

 

Background: Current US treatment guidelines recommend one dose of benzathine penicillin (BPN), for the treatment of early syphilis, regardless of HIV serostatus. Data supporting the use of this regimen in HIV-infected persons are limited. To assess the adequacy of these recommendations, we examined syphilis treatment responses and factors associated with response in the U.S. Military HIV Natural History Study [NHS], a well-characterized cohort of HIV-infected DoD beneficiaries.

Methods: NHS subjects with early syphilis were included, if they met serologic criteria for syphilis [i.e. a positive non-treponemal (NTr) test confirmed by treponemal (Tr) testing], had treatment documented in the database, and had follow up NTr titers drawn within 12 months of treatment. We defined syphilis episodes as being early if the subject had a negative NTr test in the 365 days prior to their positive NTr test. Response to treatment was assessed at 12 months. Serologic response was defined as a ≥4-fold decline in NTr titer following treatment. GEE logistic regression models were utilized to examine factors associated with response to treatment.

Results: 418 subjects [99% male, 63% African American, 24% Caucasian] experienced 604 episodes of early syphilis. 404 [67%] episodes had treatment and follow up titers recorded, in the NHS database, and are included in this analysis. 326 [81%] episodes were treated with a BPN containing regimen [121 [30%] with 1 dose, and 205 (51%) with > 1 dose]. 78 [19%] episodes were treated with a non-penicillin containing regimen. Overall, 91% of all early episodes responded to treatment [1 dose BPN-88%, >1 dose BPN-93%]. In a multivariate analysis, adjusted for age, race, antiretroviral use, HIV viral load, CD4 count and baseline NTr titers, serologic response was not affected by the number of BPN doses received [Ref: single dose of BPN; Odds Ratio [OR]: 1.60 (0.6, 4.0)]. However, having a higher CD4 count at episode diagnosis [OR per 100 cell increase: 1.41 (1.1, 1.8)] was associated with a greater likelihood of response at 12 months.

Conclusion: In this cohort serologic failure to syphilis treatment was uncommon and the number of BPN doses did not impact treatment response. Our data support the current recommendations for the use of a single dose of BPN to treat HIV-infected persons with early syphilis.

 

Anuradha Ganesan, MBBS, MPH1,2, Octavio Mesner, MS3, William P. Bradley, MS4, Jason Okulicz, MD5, Amy Weintrob, MD2, Tahaniyat Lalani, MBBS, MHS6, Mary Bavaro, MD7, Timothy Whitman, DO8,9, Chris Olsen1, Grace E Macalino, PhD3 and Brian Agan, MD10, (1)Infectious Disease Clinical Research Program, Uniformed Services University, Bethesda, MD, (2)Walter Reed National Military Medical Center, Bethesda, MD, (3)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, MD, (4)Infectious Disease Clinical Research Program (IDCRP), Uniformed Services University of the Health Sciences (USU), Bethesda, MD, (5)Infectious Disease Service, San Antonio Military Medical Center, Fort Sam Houston, TX, (6)Infectious Disease Clinical Research Program, Portsmouth, VA, (7)Naval Medical Center San Diego, San Diego, CA, (8)Infectious Diseases, Walter Reed National Military Medical Center, Bethesda, MD, (9)Uniformed Services University, Bethesda, MD, (10)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD

Disclosures:

A. Ganesan, None

O. Mesner, None

W. P. Bradley, None

J. Okulicz, None

A. Weintrob, None

T. Lalani, None

M. Bavaro, None

T. Whitman, None

C. Olsen, None

G. E. Macalino, None

B. Agan, None

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